Focused Family Planning Counseling Increases Immediate Postpartum Intrauterine Contraceptive Device Uptake: A Quasi-Experimental Study

PURPOSE

The aim of the study was to assess the effectiveness of focused family planning counseling (FFPC) in increasing postpartum intrauterine contraceptive device (PPIUCD) uptake among mothers who gave birth in the public health facilities of the towns of Adama and Olenchiti from April 1 to May 30, 2017.

METHODS

A quasi-experimental study design was employed, taking a sample of 726 postpartum mothers: 484 in the non-intervention group (NIG) and 242 in the intervention group (IG). Focused family planning counseling was given to the IG using a newly designed cue card adapted from World Health Organization (WHO) guidelines and developed based on the constructs of the health belief model. Counseling based on a routine counseling approach was given to the NIG. The interviewer administered a semi-structured questionnaire for data collection. Data were analyzed using SPSS software, version 20. Descriptive statistics were used to characterize the study participants. The difference in the proportion of PPIUCD uptake in the two groups was tested using an independent Z-test at an alpha level of 0.05. Binary logistics regression was used to identify factors associated with the odds of taking IUCD. The significance of association was declared for P-values less than 0.05.

RESULTS

The proportion of PPIUCD uptake in the IG [12.4%; 95% CI: 8.6, 17.4] was significantly higher than in the NIG [4.8%; 95% CI: 2.9, 6.7] with a P-value = 0.000. The odds of IUCD uptake among the IG was about 6 times higher (AOR: 5.92; 95% CI: 2.79, 12.60) than in the NIG. In addition, being unmarried women (AOR: 12.96; 95% CI: 4.30, 34.56), having higher education (AOR: 3.07; 95% CI: 1.13, 8.36), grand multiparity (AOR: 3.76; 95% CI: 1.58, 8.95), making a mutual decision (AOR: 0.16, 95% CI: 0.07, 0.38) and having a better knowledge of family planning (AOR: 5.92, 95% CI: 2.79, 12.60) were factors associated with uptake.

CONCLUSION

Providing FFPC immediately increases PPIUCD uptake. The uptake was also associated with marital status, education, parity, decision and knowledge on family planning.

Evaluation of a psychoeducational intervention compared with education in people with Parkinson's disease and their informal caregivers: a quasi-experimental study

AIM

To evaluate the effects of a psychoeducational intervention compared with an education programme to strengthen quality of life, psychosocial adjustment, and coping in people with Parkinson's disease and their informal caregivers.

DESIGN

A quasi-experimental study was performed with repeated measures at baseline, after the intervention and 6 months post-intervention.

METHODS

The study was carried out at seven primary care centres from 2015-2017. A total of 140 people with Parkinson's and 127 informal caregivers were allocated to the experimental and the control groups. The experimental group received a 9-week psychoeducational intervention, whereas the control group received a 5-week education programme. Repeated measures ANOVA were used to test differences in quality of life, psychosocial adjustment, and coping between the experimental and control groups and over time.

RESULTS

Patients and informal caregivers in both the experimental and control groups showed significantly better psychosocial adjustment at the post-intervention measurement compared with baseline data. We also found significantly greater quality of life in patients and coping skills in caregivers after the end of the interventions in the experimental and control groups. Nevertheless, no significant differences were identified on the outcomes at the 6-month post-intervention measurement.

CONCLUSION

The effect of the psychoeducational intervention was not different from the effect of the education programme. The strategies applied in both interventions followed a group approach led by a multidisciplinary team covering information about PD, healthy lifestyles, and social resources. They might be easily sustained in Primary Care to improve care for people with Parkinson's and informal caregivers.

Effects of a Lifestyle Intervention Based on Type D Personality in Overweight and Obese Middle-Aged Women: A Feasibility Study

BACKGROUND

Obesity is an important public health problem, particularly among middle-aged women. Type D personality, characterized by negative affectivity and social inhibition, is prevalent among obese and overweight middle-aged women and has been linked to maladaptive health-related behaviors and unhealthy lifestyle. Lifestyle interventions based on type D personality could be a first step in combatting obesity in middle-aged women.

AIM

To identify the effects of a lifestyle intervention based on type D personality on health-promoting lifestyle behaviors, psychological distress, type D personality, and body composition in overweight and obese middle-aged women.

METHODS

A total of 36 overweight and obese middle-aged women participated in a quasi-experimental design using a non-equivalent control group pretest-posttest. The experimental group received a total of eight sessions of a lifestyle intervention program based on type D personality over the course of four weeks. Outcomes were measured health-promoting lifestyle behaviors, psychological distress, type D personality, and body composition (body weight, body mass index, body fat, and abdominal fat).

RESULTS

Following the intervention, the experimental group scored significantly higher than the control group for health-promoting lifestyle behaviors, and significantly lower than the control group for psychological distress and type D personality. Body weight and body mass index decreased significantly in the experimental group compared to the control group.

LINKING EVIDENCE TO ACTION

Further research on various intervention programs for overweight and obese middle-aged women is warranted, including lifestyle interventions based on type D personality.

Mini-Basketball Training Program Improves Physical Fitness and Social Communication in Preschool Children with Autism Spectrum Disorders

This investigation examined the effects of a 12-week mini-basketball training program (MBTP) on physical fitness and social communication in preschool children with autism spectrum disorders (ASD). The study applied a quasi-experimental design. Fifty-nine preschool children aged 3-6 years with ASD were assigned to either a MBTP group (n = 30) or a control group (n = 29). Participants in the MBTP group received a scheduled mini-basketball training program (5 sessions per week, forty minutes per session) for twelve consecutive weeks, while the control group was instructed to maintain their daily activities. The physical fitness test and the parent-reported Social Responsiveness Scale Second Edition (SRS-2) test were performed before and after the intervention. Results indicated that the 12-week MBTP facilitated performance in the physical fitness test, particularly in speed-agility and muscular strength abilities. Additionally, children in the MBTP group demonstrated improvement in SRS-2 performance in social awareness, social cognition, social communication, and autistic mannerisms, whereas no such changes were found in the control group. It may be concluded that the 12-week MBTP could improve physical fitness and social communication in preschool children with ASD, and thus the use of physical exercise intervention as a therapeutic tool for preschoolers with ASD is recommended.

Impact of Health Education Intervention on Breast Cancer Awareness among Rural Women of Tamil Nadu

Background:

The most common cancer among Indian females is breast cancer. Limited access to early detection and treatment is responsible for more than half of the deaths, primarily in rural areas, where organized mammography screening is neither affordable nor feasible. Therefore, imparting awareness on breast health and breast self-examination (BSE) is highly recommended. This study aimed to assess the impact of a health education interventional program on breast health awareness and BSE among rural women of Tamil Nadu.

Methodology:

A quasi-experimental study was conducted among 266 women. A preinterventional survey was done using a pretested validated questionnaire. A multipronged breast health education intervention was administered and its effectiveness was measured after 3 months using the same tool.

Results:

There was a statistically significant (P = 0.0001) improvement in the knowledge of breast health, perceived susceptibility, and reasons for practice and proficiency of BSE practice of the interventional group from pre- to post-test. After the interventional program, 71.8% of increase in knowledge about breast health and BSE was observed. In addition, 64.7% of the women practiced BSE compared to 7.14% pretest.

Conclusion:

This study highlights the awareness needs by the women and application of extensive strategies to increase the acceptance of cancer screening programs.

Study Protocol for the Evaluation of the Health Effects of Superblocks in Barcelona: The "Salut Als Carrers" (Health in the Streets) Project

Superblocks are currently being introduced in Barcelona to respond to the city's scarcity of green spaces and high levels of air pollution, traffic injuries, and sedentariness. The aim is to calm the streets by reducing the number of square meters dedicated to private vehicles and to reclaim part of this public space for people. Salut als Carrers (Health in the Streets) is a project to evaluate the potential environmental and health effects of the superblock model with an equity perspective in Barcelona. This study aims to explain the various interventions implemented in different neighborhoods in Barcelona and the methods that will be used to evaluate them in a quasi-experimental and health impact assessment (HIA) approaches. Given the complexity of the intervention evaluated, the project employs mixed methodologies. Quantitative methods include: (a) a pre-post health survey of 1200 people randomly selected from the municipal register asked about self-perceived health and quality of life, social support, mental health, mobility, physical activity, neighborhood characteristics, and housing; (b) pre-post environmental measurements, mainly of nitrogen dioxide (NO₂), particulate matter of less than 10 µm (PM₁₀), and particulate matter of less than 2.5 µm (PM_2.5) and black carbon; (c) pre-post environmental walkability measures using the Microscale Audit of Pedestrian Streetscapes (MAPS) tool; (d) use of public space and physical activity levels using the System for Observing Play and Recreation in Communities (SOPARC), a validated observation tool; (e) pre-post traffic injury measures with a comparison group; and (f) the comparison and integration of pre-post assessment with previous HIAs and the improvement of future HIAs. Qualitative studies will be performed to analyze residents' perception of these effects by using: (a) various focus groups according to different participant characteristics who are more or less likely to use the superblocks; and (b) a guerrilla ethnography, which is a method that combines ethnographic observation and semi-structured interviews. This study, which evaluates the impact of an ambitious urban-renewal program on health, will help to assess the effectiveness of public policy in terms of health and health inequalities.

Effectiveness of pre-operative anaemia screening and increased Tranexamic acid dose policies on outcomes following unilateral primary, elective total hip or knee replacement: a statistical analysis plan for an interrupted time series and regression discontinuity study

Perioperative blood transfusion is associated with poorer postoperative outcomes following hip and knee replacement surgery. Evidence for the effectiveness of some measures aimed at reducing blood transfusions in this setting are limited and often rely on weak pre-post study designs. Quasi-experimental study designs such as interrupted time series (ITS) and regression discontinuity design (RDD) address many of the weaknesses of the pre-post study design. In addition, a priori publication of statistical analysis plans for such studies increases their transparency and likely validity, as readers are able to distinguish between pre-planned and exploratory analyses. As such, this article, written prospective of any analysis, provides the statistical analysis plan for an ITS and RDD study based on a data set of 20,772 primary elective hip and knee replacement patients in a single English NHS Trust. The primary aim is to evaluate the impact of a preoperative anaemia optimisation service on perioperative blood transfusion (within 7 days of surgery) using both ITS and RDD methods. A secondary aim is to evaluate the impact of a policy of increased tranexamic acid dose given at the time of surgery, using ITS methods.

Designs and methods for implementation research: Advancing the mission of the CTSA program

INTRODUCTION

The US National Institutes of Health (NIH) established the Clinical and Translational Science Award (CTSA) program in response to the challenges of translating biomedical and behavioral interventions from discovery to real-world use. To address the challenge of translating evidence-based interventions (EBIs) into practice, the field of implementation science has emerged as a distinct discipline. With the distinction between EBI effectiveness research and implementation research comes differences in study design and methodology, shifting focus from clinical outcomes to the systems that support adoption and delivery of EBIs with fidelity.

METHODS

Implementation research designs share many of the foundational elements and assumptions of efficacy/effectiveness research. Designs and methods that are currently applied in implementation research include experimental, quasi-experimental, observational, hybrid effectiveness-implementation, simulation modeling, and configurational comparative methods.

RESULTS

Examples of specific research designs and methods illustrate their use in implementation science. We propose that the CTSA program takes advantage of the momentum of the field's capacity building in three ways: 1) integrate state-of-the-science implementation methods and designs into its existing body of research; 2) position itself at the forefront of advancing the science of implementation science by collaborating with other NIH institutes that share the goal of advancing implementation science; and 3) provide adequate training in implementation science.

CONCLUSIONS

As implementation methodologies mature, both implementation science and the CTSA program would greatly benefit from cross-fertilizing expertise and shared infrastructures that aim to advance healthcare in the USA and around the world.

Improved breastfeeding duration with Baby Friendly Hospital Initiative implementation in a diverse and underserved population

BACKGROUND

Few studies have evaluated the impact of Baby Friendly Hospital Initiative (BFHI) implementation on underserved populations in the United States. We undertook this study in New Mexico, a large southwestern state with a diverse population and limited health care access.

METHODS

A quasi-experimental, retrospective cohort design was used to compare short-term breastfeeding duration between a pre-BFHI and a post-BFHI cohort. Among the post-BFHI cohort, logistic regression models were fitted to predict short-term breastfeeding duration from both individual and cumulative exposure to inpatient maternity care practices (Steps 4 to 9).

RESULTS

Implementation of the BFHI and cumulative exposure to the Ten Steps increased short-term duration of any breastfeeding and exclusive breastfeeding at 2-6 weeks postpartum. Exposure to all six of the inpatient Ten Steps increased the odds of any breastfeeding by 34 times and exclusive breastfeeding by 24 times. Exposure to Step 9 ("Give no pacifiers or artificial nipples") uniquely increased the likelihood of any breastfeeding at 2-6 weeks postpartum by 5.7 times, whereas Step 6 ("Give infants no food or drink other than breastmilk") increased the rate of exclusive breastfeeding by 4.4 times at 2-6 weeks postpartum.

CONCLUSION

These findings demonstrate that the Baby Friendly Hospital Initiative can have a positive impact on breastfeeding among underserved populations.

Effects of ecotourism on forest loss in the Himalayan biodiversity hotspot based on counterfactual analyses

Ecotourism is developing rapidly in biodiversity hotspots worldwide, but there is limited and mixed empirical evidence that ecotourism achieves positive biodiversity outcomes. We assessed whether ecotourism influenced forest loss rates and trajectories from 2000 to 2017 in Himalayan temperate forests. We compared forest loss in 15 ecotourism hubs with nonecotourism areas in 4 Himalayan countries. We used matching statistics to control for local-level determinants of forest loss, for example, population density, market access, and topography. None of the ecotourism hubs was free of forest loss, and we found limited evidence that forest-loss trajectories in ecotourism hubs were different from those in nonecotourism areas. In Nepal and Bhutan, differences in forest loss rates between ecotourism hubs and matched nonecotourism areas did not differ significantly, and the magnitude of the estimated effect was small. In India, where overall forest loss rates were the lowest of any country in our analysis, forest loss rates were higher in ecotourism hubs than in matched nonecotourism areas. In contrast, in China, where overall forest loss rates were highest, forest loss rates were lower in ecotourism hubs than where there was no ecotourism. Our results suggest that the success of ecotourism as a forest conservation strategy, as it is currently practiced in the Himalaya, is context dependent. In a region with high deforestation pressures, ecotourism may be a relatively environmentally friendly form of economic development relative to other development strategies. However, ecotourism may stimulate forest loss in regions where deforestation rates are low.

Patient safety before and after implementing person-centred inpatient care - A quasi-experimental study

AIMS AND OBJECTIVES

To evaluate aspects of patient safety before and after a person-centred (PC) inpatient care intervention.

BACKGROUND

Transitioning from disease-centred to person-centred care requires great effort but can improve patient safety.

DESIGN

A quasi-experimental study with data collection preceding and 12 months after a PC inpatient care intervention.

METHODS

The study consecutively recruited adult patients (2014, n = 263; 2015/2016, n = 221) admitted to an inpatient care unit. The patients reported experiences of care at discharge and their perceived pain at admission and discharge. Medical records were reviewed to gather data on medications, planned care and clinical observations. The study is reported according to TREND guidelines.

RESULTS

At discharge, patients receiving PC inpatient care reported competent medical-technical care. Patients receiving PC inpatient care reported more effective pain relief. Updated prescribed medications at the ward were maintained, and patients were made aware of planned medical care to higher extent during PC inpatient care. The assessment of pulse and body temperature was maintained, but fewer elective care patients had their blood pressure taken during PC inpatient care. Weight assessment was not prioritised during usual or PC inpatient care.

CONCLUSIONS

Patients receiving PC inpatient care reported that they were given the best possible care and had less pain at discharge. The PC inpatient care included improved documentation and communication of planned medical care to the patients. Vital signs were more frequently recorded for patients admitted for acute care than patients admitted for elective care. PC inpatient care had no effect on frequency of weight measurements.

RELEVANCE TO CLINICAL PRACTICE

PC inpatient care seems beneficial for the patients. Aspects of patient safety such as prescribed medications were maintained, and PC inpatient care seems to enhance the continuity of care. Inpatient clinical observations need further evaluation as healthcare transitions from disease-centred to person-centred care.

Optimizing the observer experience in an interprofessional home health simulation: a quasi-experimental study

The purpose of this quasi-experimental study was to explore the influence of an interprofessional simulation experience on student perceptions of interprofessional collaboration, as well as to explore the influence of the participant and observer roles on these beliefs. A two-session simulation experience was developed to engage professional students in the collaborative care of a patient admitted to a home health agency. To provide the simulation experience in a time efficient manner within the curriculum, students participated in two interprofessional teams of nursing and physical therapy students. Each team actively participated in the collaborative care of the patient in one session. In the alternate session, the interprofessional team observed the care of the patient, documented behaviors ideal for interprofessional teamwork, and provided feedback regarding the interprofessional collaboration and communication observed during debriefing. Observers in this study consistently improved their self-perceived comfort in working with others irrespective of the order in which they participated in the simulation scenario. The use of observers in simulation may provide opportunities for programs to integrate large scale simulation experiences in a time efficient manner to further engage students in active learning as a component of interprofessional education.

Enhancing Health Through Access to Nature: How Effective are Interventions in Woodlands in Deprived Urban Communities? A Quasi-experimental Study in Scotland, UK

High prevalence of poor mental health is a major public health problem. Natural environments may contribute to mitigating stress and enhancing health. However, there is little evidence on whether community-level interventions intended to increase exposure to natural environments can improve mental health and related behaviours. In the first study of its kind, we evaluated whether the implementation of a programme designed to improve the quality of, and access to, local woodlands in deprived communities in Scotland, UK, was associated with lower perceived stress or other health-related outcomes, using a controlled, repeat cross-sectional design with a nested prospective cohort. Interventions included physical changes to the woodlands and community engagement activities within the woodlands, with data collected at baseline (2013) and post-intervention (2014 and 2015). The interventions were, unexpectedly, associated with increased perceived stress compared to control sites. However, we observed significantly greater increases in stress for those living >500 m from intervention sites. Visits to nearby nature (woods and other green space) increased overall, and moderate physical activity levels also increased. In the intervention communities, those who visited natural environments showed smaller increases in stress than those who did not; there was also some evidence of increased nature connectedness and social cohesion. The intervention costs were modest but there were no significant changes in quality of life on which to base cost-effectiveness. Findings suggest factors not captured in the study may have contributed to the perceived stress patterns found. Wider community engagement and longer post-intervention follow-up may be needed to achieve significant health benefits from woodland interventions such as those described here. The study points to the challenges in evidencing the effectiveness of green space and forestry interventions to enhance health in urban environments, but also to potential benefits from more integrated approaches across health and landscape planning and management practice.

Person-centred inpatient care - A quasi-experimental study in an internal medicine context

AIM

The aim of this study was to evaluate effects of person-centred inpatient care on care processes in terms of satisfaction with care and person-centred content in medical records, and to evaluate effects on self-reported health and self-efficacy.

BACKGROUND

Internal medicine inpatient care is complex, covering patients varying in age, medical conditions, health status, and other aspects. There has been limited research on the impact of person-centred care (PCC) on satisfaction with care and health outcomes in internal medicine care environments regardless of diagnosis and care pathway.

DESIGN

A quasi-experimental study with pre- and postmeasurements.

METHODS

Adult patients admitted to an internal medicine inpatient unit were consecutively included over 16 weeks in 2014 and 24 weeks in 2015-2016. Data were collected before a person-centred inpatient care intervention (N = 204) and 12 months after the intervention was implemented (N = 177). Data on satisfaction with care and self-reported health were collected at discharge and medical records were reviewed. The intervention included systematically applied person-centred assessment, health plans, and persistent PCC.

RESULTS

After the intervention, patients rated higher satisfaction with care regarding essential components of PCC and more patients had received effective pain relief. There were no differences in information on self-care or medications, self-rated health, or self-efficacy.

CONCLUSION

Care focused on the foundations of person-centredness seems to enhance both patients' perceptions of satisfaction and symptom management. Situational aspects such as care pathways should be considered when implementing person-centred inpatient care.

TRIAL REGISTRATION

CLINICALTRIALS.

GOV, REGISTRATION NUMBER

NCT03725813.

Maternal infection requiring hospitalization during pregnancy and attention-deficit hyperactivity disorder in offspring: a quasi-experimental family-based study

BACKGROUND

Maternal infection during pregnancy (IDP) has been associated with increased risk of attention-deficit/hyperactivity disorder (ADHD) in offspring. However, infection is associated with social adversity, poor living conditions and other background familial factors. As such, there is a need to rule out whether the observed association between maternal IDP and ADHD might be attributed to such confounding.

METHODS

This nationwide population-based cohort study using a family-based, quasi-experimental design included 1,066,956 individuals born in Sweden between 1992 and 2002. Data on maternal IDP (bacterial or viral) requiring hospitalization and ADHD diagnosis in offspring were gathered from Swedish National Registers, with individuals followed up through the end of 2009. Ordinary and stratified Cox regression models were used for estimation of hazard ratios (HRs) and several measured covariates were considered. Cousin- and sibling-comparisons accounted for unmeasured genetic and environmental factors shared by cousins and siblings.

RESULTS

In the entire population, maternal IDP was associated with ADHD in offspring (HR = 2.31, 95% CI = 2.04-2.61). This association was attenuated when accounting for measured covariates (HR = 1.86, 95% CI = 1.65-2.10). The association was further attenuated when adjusting for unmeasured factors shared between cousins (HR = 1.52, 95% CI = 1.12-2.07). Finally, the association was fully attenuated in sibling comparisons (HR = 1.03, 95% CI = 0.76-1.41).

CONCLUSIONS

This study suggests that the association between maternal IDP and offspring ADHD is largely due to unmeasured familial confounding. Our results underscore the importance of adjusting for unobserved familial risk factors when exploring risk factors for ADHD.

Impact of abolishing prescription fees in Scotland on hospital admissions and prescribed medicines: an interrupted time series evaluation

OBJECTIVES

To identify whether the abolition of prescription fees in Scotland resulted in: (1) Increase in the number (cost to NHS) of medicines prescribed for which there had been a fee (inhaled corticosteroids). (2) Reduction in hospital admissions for conditions related to those medications for which there had been a fee (asthma or chronic obstructive pulmonary disease (COPD))-when both are compared with prescribed medicines and admissions for a condition (diabetes mellitus) for which prescriptions were historically free.

DESIGN

Natural experimental retrospective general practice level interrupted time series (ITS) analysis using administrative data.

SETTING

General practices, Scotland, UK.

PARTICIPANTS

732 (73.6%) general practices across Scotland with valid dispensed medicines and hospital admissions data during the study period (July 2005-December 2013).

INTERVENTION

Reduction in fees per dispensed item from April 2008 leading to the abolition of the fee in April 2011, resulting in universal free prescriptions.

PRIMARY AND SECONDARY OUTCOMES

Hospital admissions recorded in the Scottish Morbidity Record - 01 Inpatient (SMR01) and dispensed medicines recorded in the Prescribing Information System (PIS).

RESULTS

The ITS analysis identified marked step reductions in adult (19-59 years) admissions related to asthma or COPD (the intervention group), compared with older or young people with the same conditions or adults with diabetes mellitus (the counterfactual groups). The prescription findings were less coherent and subsequent sensitivity analyses found that both the admissions and prescriptions data were highly variable above the annual or seasonal level, limiting the ability to interpret the findings of the ITS analysis.

CONCLUSIONS

This study did not find sufficient evidence that universal free prescriptions was a demonstrably effective or ineffective policy, in terms of reducing hospital admissions or reducing socioeconomic inequality in hospital admissions, in the context of a universal, publicly administered medical care system, the National Health Service of Scotland.

Needs and Challenges Related to Multilevel Interventions: Physical Activity Examples

The theme of this commentary is to discuss the need for, and challenges of, conceptualizing, implementing, and evaluating multilevel health behavior change interventions. Ecological models, recommendations from national and international authoritative groups, and growing evidence all support the need for interventions designed to change multiple levels of influence, including individuals, social environments, organizations, built environments, and policies, to achieve population improvements in public health. Though multilevel interventions are becoming more common in practice, they are still under-used, and research on multilevel interventions is relatively rare. Drawing on examples from physical activity, several types of evidence are summarized to demonstrate that multilevel interventions are feasible and can be effective. Serious challenges to implementing and evaluating multilevel interventions include the need for teams with diverse expertise, lack of control over intervention implementation, unpredictability of timelines, managing complex teams over extended periods, and need to apply unfamiliar and less-rigorous study designs and methods. Recommendations are offered for changes in training, funding priorities, and academic incentives that could lead to more and better multilevel interventions.

Team Resilience Training in the Workplace: E-Learning Adaptation, Measurement Model, and Two Pilot Studies

BACKGROUND

The majority of resilience interventions focus on the individual. Workplace resilience is a growing field of research. Given the ever-increasing interconnectedness in businesses, teamwork is a guarantee. There is also growing recognition that resilience functions at the team level.

OBJECTIVE

The objective of our work was to address three shortcomings in the study of workplace resilience interventions: lack of interventions focusing on group-level or team resilience, the need for brief interventions, and the need for more theoretical precision in intervention studies.

METHODS

The authors took an established evidence-based program (Team Resilience) and modified it based on these needs. A working model for brief intervention evaluation distinguishes outcomes that are proximal (perceptions that the program improved resilience) and distal (dispositional resilience). A total of 7 hypotheses tested the model and program efficacy.

RESULTS

Two samples (n=118 and n=181) of engineering firms received the Web-based training and provided immediate reactions in a posttest-only design. The second sample also included a control condition (n=201). The findings support the model and program efficacy. For example, workplace resilience was greater in the intervention group than in the control group. Other findings suggest social dissemination effects, equal outcomes for employees at different stress levels, and greater benefit for females.

CONCLUSIONS

This preliminary research provides evidence for the capabilities of e-learning modules to effectively promote workplace resilience and a working model of team resilience.

If You Build It, Will They Come? A Quasi-experiment of Sidewalk Improvements and Physical Activity

Improving sidewalks could lead to more physical activity through improved access, while providing a safe and defined space to walk. Yet, findings on the association between sidewalks and physical activity are inconclusive.

PURPOSE

The purpose of this study was to examine changes in self-reported and accelerometer-derived physical activity associated with living near recently improved sidewalks in a diverse, community-based sample from the Houston Travel Related Activity in Neighborhoods (TRAIN) Study.

METHODS

Data are from 430 adults and include baseline and first annual follow-up (2014-2017). Fully adjusted, two-step regression models were built to test the hypothesis that living near (within 250-meters) an improved sidewalk was associated with greater levels of physical activity than not living near an improved sidewalk.

RESULTS

The majority of participants were female, non-Hispanic black, low income, low education, and nearly half lived near at least one improved sidewalk. After adjustment, among participants reporting some physical activity, living near two sidewalk improvements was associated with 1.6 times more minutes per week of walking and leisure-time physical activity than those not living near a sidewalk improvement (p<0.05). Based on accelerometry, which does not specifically quantify domain-specific physical activity, there were no significant associations.

CONCLUSION

Although these mixed findings warrant further research, results suggest that improving sidewalks may have an effect on participants' physical activity. Nonspecific definitions of sidewalk improvements could be contributing to type 1 error. Future work should also examine behavioral interventions alongside changes to the built environment to determine the effects on physical activity.

Impact of the community-based newborn care package in Nepal: a quasi-experimental evaluation

OBJECTIVE

To evaluate the impact of the community-based newborn care package (CBNCP) on six essential practices to improve neonatal health.

METHODS

CBNCP pilot districts were matched to comparison districts using propensity scores. Impact on birth preparedness, antenatal care seeking, antenatal care quality, delivery by skilled birth attendant, immediate newborn care and postnatal care within 48 hours were assessed using Demographic and Health Survey (DHS) and Health Management Information System (HMIS) data through difference-in-differences and multivariate logistic regression analyses.

FINDINGS

Changes over time in intervention and comparison areas were similar in difference-in-differences analysis of DHS and HMIS data. Logistic regression of DHS data also did not reveal any significant improvement in combined outcomes: birth preparedness, adjusted OR (aOR)=0.8 (95% CI 0.4 to 1.7); antenatal care seeking, aOR=1.0 (0.6 to 1.5); antenatal care quality, aOR=1.4 (0.9 to 2.1); delivery by skilled birth attendant, aOR=1.5 (1.0 to 2.3); immediate newborn care, aOR=1.1 (0.7 to 1.9); postnatal care, aOR=1.3 (0.9 to 1.9). Health providers' knowledge and skills in intervention districts were fair but showed much variation between different providers and districts.

CONCLUSIONS

This study, while representing an early assessment of impact, did not identify significant improvements in newborn care practices and raises concerns regarding CBNCP implementation. It has contributed to revisions of the package and it being merged with the Integrated Management of Neonatal and Childhood Illness programme. This is now being implemented in 35 districts and carefully monitored for quality and impact. The study also highlights general challenges in evaluating the impacts of a complex health intervention under 'real life' conditions.

Educational Module Intervention for Radiographers to Reduce Repetition Rate of Routine Digital Chest Radiography in Makkah Region of Saudi Arabia Tertiary Hospitals: Protocol of a Quasi-Experimental Study

Background

Repetition of an image is a critical event in any radiology department. When the repetition rate of routine digital chest radiographs is high, radiation exposure of staff and patients is increased. In addition, repetition consumes the equipment’s life span, thus affecting the annual budget of the department.

Objective

The aim of this study is to determine the impact of a printed educational module on reducing the repetition rate of routine digital chest radiography among radiographers in Makkah Region tertiary hospitals.

Methods

A quasi-experimental time series with a control group will be conducted in Makkah Region tertiary hospitals for 8 months starting in the second quarter of 2017. Four hospitals out of 5 in the region will be selected; 2 of them will be selected as the control group and the other 2 as the intervention group. Stratification and a simple random sampling technique will be used to sample 56 radiographers in each group. Pre- and postintervention assessments will be conducted to determine the radiographer knowledge, motivation, and skills and repetition rate of chest radiographs. Radiographs of the chest performed by sampled radiographers in the selected hospitals will be collected for 2 weeks before and after the intervention. A piloted questionnaire will be distributed and collected by a researcher in both groups. One-way multivariate analysis of variance and 2-way repeated multivariate analysis of variance will be used to analyze the data.

Results

It is expected that the repetition rate in the intervention group will decline after implementing the intervention and the change will be statistically significant (P<.05). Furthermore, it is expected that the knowledge, motivation, and skill levels in the intervention group will increase significantly among radiographers after implementation of the intervention (P<.05). Meanwhile, knowledge, motivation, and skills in the control group will not change.

Conclusions

A quasi-experimental time series with a control will be conducted to investigate the effect of printed educational material in reducing the repetition rate of routine digital chest radiographs among radiographers in tertiary hospitals in the Makkah Region of Saudi Arabia.

Patient Navigation Improves Subsequent Breast Cancer Screening After a Noncancerous Result: Evidence from the Patient Navigation in Medically Underserved Areas Study

BACKGROUND

Past efforts to assess patient navigation on cancer screening utilization have focused on one-time uptake, which may not be sufficient in the long term. This is partially due to limited resources for in-person, longitudinal patient navigation. We examine the effectiveness of a low-intensity phone- and mail-based navigation on multiple screening episodes with a focus on screening uptake after receiving noncancerous results during a previous screening episode.

METHODS

The is a secondary analysis of patients who participated in a randomized controlled patient navigation trial in Chicago. Participants include women referred for a screening mammogram, aged 50-74 years, and with a history of benign/normal screening results. Navigation services focused on identification of barriers and intervention via shared decision-making processes. A multivariable logistic regression intent-to-treat model was used to examine differences in odds of obtaining a screening mammogram within 2 years of the initial mammogram (yes/no) between navigated and non-navigated women. Sensitivity analyses were conducted to explore patterns across subsets of participants (e.g., navigated women successfully contacted before the initial appointment; women receiving care at Hospital C).

RESULTS

The final sample included 2,536 women (741 navigated, 1,795 non-navigated). Navigated women exhibited greater odds of obtaining subsequent screenings relative to women in the standard care group in adjusted models and analyses including women who received navigation before the initial appointment.

CONCLUSIONS

Our findings suggest that low-intensity navigation services can improve follow-up screening among women who receive a noncancerous result. Further investigation is needed to confirm navigation's impacts on longitudinal screening.

Effect of health education on awareness about oral cancer and oral self-examination

CONTEXT

Oral cancer is preceded by visible changes in the oral mucosa. These lesions can be detected by oral self-examination, but awareness about oral cancer is still low in developing countries.

AIM

To evaluate the effect of health education on awareness about oral cancer and oral self-examination.

SETTINGS AND DESIGN

Quasi-experimental trial was conducted in an urban resettlement colony of Chandigarh, India.

MATERIALS AND METHODS

A brochure having information and pictorials on oral lesions was used for conducting health education sessions on a one-to-one basis in the household setting among 85 males in age group 15-59 years during 2013, and each participant was encouraged to perform an oral self-examination. Study participants were interviewed about their awareness on oral cancer and oral self-examination before- and after-health education using a pretested interview schedule.

STATISTICAL ANALYSIS

Awareness items were scored, and mean change in awareness score was computed. Paired t-test was used for testing statistical significance.

RESULTS

Thirty-three percent of the study participants were current smokers, 25% consumed alcohol, and 9.4% chewed tobacco. The awareness scores after health education increased significantly from 5.3 to 6.7 (P < 0.05), and 34% of the tobacco or alcohol users expressed their intention to quit these habits, and two persons actually quit tobacco chewing. Out of the 77 study participants who performed oral self-examination, nine were able to detect lesions, and one was found to have submucous fibrosis.

CONCLUSIONS

Health education intervention was able to initiate a favorable behavior change in the community. Hence, oral self-examination programs should be promoted.

Persistent threats to validity in single-group interrupted time series analysis with a cross over design

RATIONALE, AIMS AND OBJECTIVES

The basic single-group interrupted time series analysis (ITSA) design has been shown to be susceptible to the most common threat to validity-history-the possibility that some other event caused the observed effect in the time series. A single-group ITSA with a crossover design (in which the intervention is introduced and withdrawn 1 or more times) should be more robust. In this paper, we describe and empirically assess the susceptibility of this design to bias from history.

METHOD

Time series data from 2 natural experiments (the effect of multiple repeals and reinstatements of Louisiana's motorcycle helmet law on motorcycle fatalities and the association between the implementation and withdrawal of Gorbachev's antialcohol campaign with Russia's mortality crisis) are used to illustrate that history remains a threat to ITSA validity, even in a crossover design.

RESULTS

Both empirical examples reveal that the single-group ITSA with a crossover design may be biased because of history. In the case of motorcycle fatalities, helmet laws appeared effective in reducing mortality (while repealing the law increased mortality), but when a control group was added, it was shown that this trend was similar in both groups. In the case of Gorbachev's antialcohol campaign, only when contrasting the results against those of a control group was the withdrawal of the campaign found to be the more likely culprit in explaining the Russian mortality crisis than the collapse of the Soviet Union.

CONCLUSIONS

Even with a robust crossover design, single-group ITSA models remain susceptible to bias from history. Therefore, a comparable control group design should be included, whenever possible.